机器人系统在结直肠肿瘤外科中的应用现状与挑战

使用机器人系统治疗结直肠肿瘤是微创外科领域重大改革和创新,并被证实安全可行。相比腹腔镜手术,机器人手术操作空间大且中转开腹率低。但是,机器人手术吻合口并发症发生率及泌尿生殖功能保护能力仍存争议,切除肿瘤远期效果与腹腔镜相比未见显著优势,有待进一步随访数据证实。目前机器人系统不断升级和改进,与更多新技术智能结合希望促进机器人手术推广普及。本文旨在阐述机器人系统在结直肠肿瘤根治术中发展现状,展望其应用前景。     

腹腔镜及机器人手术在结直肠癌肝转移治疗中的合理应用及评价

手术切除是惟一有希望治愈结直肠癌肝转移的手段。随着微创技术的不断进步,腹腔镜和机器人技术越来越多地应用于结直肠癌肝转移的手术治疗中,并取得了较好的疗效。腹腔镜和机器人技术的应用,只有在结直肠癌肝转移外科治疗的总体原则框架下,严格把握手术指征,合理选择手术时机,才能充分发挥微创技术的优势,以更小的创伤、更小的打击和更小的风险使结直肠癌肝转移病人得到合理的治疗。临床上,在充分考虑每个病人的整体情况后,经过多学科综合治疗协作组讨论,合理应用腹腔镜及机器人等手术方式,将扩大微创手术治疗的优势,给更多的结直肠癌肝转移病人带来更佳的近期和远期疗效。     

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手术切除是惟一有希望治愈结直肠癌肝转移的手段。随着微创技术的不断进步,腹腔镜和机器人技术越来越多地应用于结直肠癌肝转移的手术治疗中,并取得了较好的疗效。腹腔镜和机器人技术的应用,只有在结直肠癌肝转移外科治疗的总体原则框架下,严格把握手术指征,合理选择手术时机,才能充分发挥微创技术的优势,以更小的创伤、更小的打击和更小的风险使结直肠癌肝转移病人得到合理的治疗。临床上,在充分考虑每个病人的整体情况后,经过多学科综合治疗协作组讨论,合理应用腹腔镜及机器人等手术方式,将扩大微创手术治疗的优势,给更多的结直肠癌肝转移病人带来更佳的近期和远期疗效。     

机器人辅助腹腔镜技术现状与前景

随着传统腹腔镜技术的广泛应用,现代外科进入了微创化时代。但传统腹腔镜设备的局限性,极大地限制了微创外科的进一步发展。新出现的机器人辅助腹腔镜（外科机器人）技术,超越了传统外科与腹腔镜技术的局限性,其卓越的三维视野以及更好的灵巧性,能够安全完成更精细和复杂的操作,因而外科机器人技术正逐步渗透到外科各亚专科领域,将预示微创外科新纪元的来临。     

达芬奇机器人手术系统在子宫内膜癌手术中的应用

子宫内膜癌的治疗原则以外科手术为主。达芬奇机器人手术作为一种微创手术,在过去10年的发展中技术日臻成熟,在妇科肿瘤微创手术领域正扮演越来越重要的角色。相比传统腹腔镜手术,达芬奇机器人手术系统的主要优势有:改进的三维立体术野,机械腕提高了手术灵巧度,震颤过滤系统提高了操作精准度。这些技术上的改进可以帮助妇科肿瘤医生为病情更加复杂的患者完成高难手术,尤其对于子宫内膜癌合并重度肥胖者。本文总结达芬奇机器人手术系统在子宫内膜癌治疗中的应用进展,与开腹手术和传统腹腔镜手术进行对比,有关新型机器人手术系统、创新、适用人群和学习曲线方面的内容也有涉及。     

腹部微创外科的过去、现在与未来

过去的100年,科技进步为外科领域带来了众多新器械、新技术、新观念,以腹腔镜技术为代表的微创手术方兴未艾。光学技术、微型化技术和机器人技术的发展为微创外科开辟了广阔的应用前景,遥控机器人手术、经自然孔道手术和新型手术导航系统将在不远的将来进入临床,使微创外科发生前所未有的变革。本文回顾了微创外科的发展历程,及其在腹部外科的应用现状与发展方向。     

机器人肝切除治疗早期肝癌的相关问题探讨

近30年来，肝脏微创手术取得了巨大发展，而机器人手术系统的临床应用有望解决一系列腹腔镜手术所面临的难题。经验丰富的外科医师在开腹及腹腔镜肝切除术的基础上，根据机器人手术系统的实际情况做了大量改进和优化工作，是传统微创手术安全、可行、有效的替代方式。该文对机器人治疗早期肝癌的适应证、手术策略、近期临床结局和远期肿瘤学效果等方面进行了探讨。     

浅谈微创手术在妇科恶性肿瘤领域的现状

微创手术是外科领域近30年来最伟大的技术革新。与传统开放手术相比,它大大减少了手术创伤和切口相关并发症,如手术部位感染、术后疼痛、疝等,微创手术也缩短了在院时间,保持了腹壁皮肤的完整性。尽管如此,微创手术技术仍在进一步更新,因为传统腹腔镜手术存在深度感知受限、摄像机稳定性欠缺、运动范围有限、学习曲线陡峭等局限性。因此,20世纪80年代以来,为克服传统腹腔镜技术所遇到的瓶颈,在复杂手术中提高手术的准度和精度,促进微创手术的革新和广泛应用,机器人手术系统应运而生,它改进了三维立体视觉、扩大了术者视野、提高了操作设备的灵巧性、降低了可能影响手术精度的震颤。目前,机器人手术系统作为一个前沿的微创手术方法已广泛应用于妇科领域,尤其是妇科恶性肿瘤领域。笔者通过回顾文献,并结合自己的经验,总结达芬奇机器人系统在妇科恶性肿瘤领域的应用效果。     

腹腔镜肝胆胰手术操作指南

<正>世界首例腹腔镜胆囊切除术的成功开展标志着肝胆胰微创外科时代的到来。与传统开腹手术相比,腹腔镜手术具有创伤更小、全身反应更轻、术中出血更少、住院时间更短、发病率更低及美容效果更好等优势。越来越多的以腹腔镜手术为代表的微创技术正在逐步取代传统的手术操作。肝胆胰外科是腹部外科中最复杂、创伤最大的外     

机器人辅助机械臂手术系统在腹腔镜手术中的应用

近年来，腹腔镜手术技术不断成熟，手术范围不断扩大。同时微创外科也在向智能化、网络化、信息化方向发展。美国航空航天局批准研究的机器人手术系统是外科医师进行微创外科手术技术革新的有力工具，该系统为腹腔镜手术提供了清晰且稳定的图像，为手术的顺利完成提供了可靠保证。我院自2003年8月至2004年3月应用AESOP3000型 HERMES智能机器人手术系统共完成机器人辅助下的腹腔镜手术33例，现报告如下。     

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??Application situation of robotic surgical system in the general surgery QIN Xin-yu. Department of General Surgery??Zhongshan Hospital, Fudan University??Shanghai 200032??China
Abstract With the development of the surgical concept and surgical instruments??the general surgery has developed into the era of mini-invasive surgery time. Robotic surgical system has been applied into all specialized field of general surgery??for example??gastrointestinal??hepatobiliary??pancreatic and thyroid operations??and has showed some typical characteristics. Although compared with the traditional laparoscopy??robotic surgical system still has not displayed significant advantages and been more expensive. But with the popularization and large-scale installation??robotic surgical system may be the new era of the mini-invasive time of the general surgery.     

机器人手术系统在普通外科临床应用现状

随着外科理念和手术器械的不断进步,普通外科业已进入微创时代。机器人手术系统已经在普通外科各专科中广泛应用。在胃肠外科、肝胆胰外科和甲状腺外科领域中,机器人手术系统均已显示出其独特的价值。虽然与传统腹腔镜技术相比,机器人手术系统在很多方面尚未显示出明显优势,价格也较为昂贵,但随着设备的普及和规模化,其有望开创微创外科的新纪元。     

精准医学在胃癌中的研究进展

得益于各种分子生物学技术以及基因测序等的进步,胃癌在发病机制研究、分子分型以及靶向治疗等方面有不小的突破。借助于最新的液体活检技术,在评判胃癌病人预后以及对药物或者治疗的反应性方面有了突飞猛进的发展。而光学和物理学的进步推动了内窥镜在胃癌早期诊断以及早期治疗中的发展,同时推动了腹腔镜在进展期胃癌中的广泛开展,高清3D腹腔镜和机器人手术的使用推动了一系列新的手术方式和理念的出现,微创外科的快速发展又推动了加速术后康复(ERAS)理念在胃癌领域的推广。而这些精确诊断、靶向治疗、微创手术、ERAS、精准预判预后均体现了精准医学的精髓,推动着胃癌基础研究和临床诊疗的进步。     

机器人胃癌根治术相关问题

近10年来,机器人外科手术系统的临床应用取得了长足发展,其有望解决腹腔镜技术本身的缺陷.经验丰富的外科医生团队在腹腔镜胃癌根治术的基础上,应用机器人进行手术和开展临床研究已经积累了许多成功经验.临床机器人系统为微创手术提供了一个技术上优越的手术环境,是传统腹腔镜胃癌根治术有效、可行的替代方法.该文就机器人胃癌根治术的可...     

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??Application and evaluation of laparoscopy and robot in the treatment of malignant liver tumor PENG Cheng-hong, ZHAO Shu-lin, JIN Jia-bin. Department of General Surgery, Ruijin Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University??Shanghai 200025??China
Corresponding author: PENG Cheng-hong, E-mail: chhpeng@188.com
Abstract Minimally invasive surgery has become the fist choice for surgical diseases, which lead to more and more application of laparoscopy and robot surgery in liver cancers. In lots of liver surgery centers, the minimally invasive surgeries are taken as the first choice. Although there are some success approaches??laparoscopy is not widely spread in liver resection surgeries such as segment ??/??/?? resection. Robotic surgery may be more practical in operations related to those regions because of its unique technical advantages. For the oncological outcomes of liver cancers??laparoscopy and laparotomy are almost equivalent. Laparotomy??laparoscopic surgery and robot assisted surgery will coexist for a long time. The three operative methods have their own advantages and indications. Individualized choice of surgical method is especially important for patients.     

Surgical treatment of ureteropyelic junction stenosis using robotic-assisted laparoscopy

Since the introduction of mini-invasive surgery approximately thirty years ago, Laparoscopic surgery has significantly evolved both in terms of its extended field of application and of the tools used which were diversified and improved. More recently, the development of robotic-assisted laparoscopy has brought, among other improvements, three-dimensional vision, dexterity, and a comfortable working position, which have reduced the surgeon's fatigability, the difficulties related to the operations and the learning curves of standard laparoscopy. Urology, which makes slightly less use of standard laparoscopy than general or gynaecological surgery, largely benefits from robotics concerning the precision of movements, and has much increased the operating indications of laparoscopy, including the treatment of pyeloureteral junction, kidney tumourectomy, living donor nephrectomy and radical prostactectomy. This chapter describes the operative technique used for the treatment of the ureteropyelic junction stenosis by robotic-assisted laparoscopy, as carried out in Nancy University Hospital with the da Vinci robot (Intuitive Surgical).     

Superiority of laparoscopic rectal surgery: Towards a new era

While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anatomy of the pelvis,immature procedures of rectal transaction and so on.On the other hand,maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness.However,some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes.This review article discusses how to keep a clear operative field,removing normally existing abdominal structures,and how to transact the rectum and restore the discontinuity based on anatomical investigations.According to this review,laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far,actually entering a new era.     

腹腔镜及机器人技术在肝脏恶性肿瘤治疗中的应用及评价

微创手术正成为外科疾病诊疗的首选方法。腹腔镜及机器人在肝脏恶性肿瘤的微创治疗中的应用越来越多,在较多的肝脏外科中心已经是首选方案。但是,对于肝脏Ⅰ、Ⅶ、Ⅷ段的手术等,腹腔镜虽有成功尝试,但尚未广泛推广,而机器人辅助手术因其特有的技术优势,对这些特殊部位手术会更方便。对于肝脏恶性肿瘤的手术疗效,微创手术已获得与开放手术相似的效果。开放手术、腹腔镜手术及机器人辅助手术会在今后相当长一段时间内共存,三种术式有着各自的优势,各自的适应证,个体化的术式选择尤为重要。     

Mobile in vivo camera robots provide sole visual feedback for abdominal exploration and cholecystectomy

The use of small incisions in laparoscopy reduces patient trauma, but also limits the surgeon’s ability to view and touch the surgical environment directly. These limitations generally restrict the application of laparoscopy to procedures less complex than those performed during open surgery. Although current robot-assisted laparoscopy improves the surgeon’s ability to manipulate and visualize the target organs, the instruments and cameras remain fundamentally constrained by the entry incisions. This limits tool tip orientation and optimal camera placement. The current work focuses on developing a new miniature mobile in vivo adjustable-focus camera robot to provide sole visual feedback to surgeons during laparoscopic surgery. A miniature mobile camera robot was inserted through a trocar into the insufflated abdominal cavity of an anesthetized pig. The mobile robot allowed the surgeon to explore the abdominal cavity remotely and view trocar and tool insertion and placement without entry incision constraints. The surgeon then performed a cholecystectomy using the robot camera alone for visual feedback. This successful trial has demonstrated that miniature in vivo mobile robots can provide surgeons with sufficient visual feedback to perform common procedures while reducing patient trauma.     

达芬奇机器人甲状腺切除术的现状与发展

机器人甲状腺手术发展迅速，形成了多种手术方式和手术径路。其在甲状腺的领域的应用改变了甲状腺疾病传统的诊疗模式，为甲状腺外科带来了新方法和新思路。在外科领域机器人平台与人工智能的结合已经逐步成为趋势，甲状腺外科医生必须转变思维模式、接受智能技术、不断探索学习，在人工智能与机器人时代实现职业生涯的可持续发展。